Provider Demographics
NPI:1093231151
Name:AUBUCHON, KRISTIN BLAIR (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:BLAIR
Last Name:AUBUCHON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 GRAVOIS RD
Mailing Address - Street 2:STE 100
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7723
Mailing Address - Country:US
Mailing Address - Phone:636-326-6100
Mailing Address - Fax:636-326-6110
Practice Address - Street 1:714 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7723
Practice Address - Country:US
Practice Address - Phone:636-326-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-20
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017029177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420046733Medicaid